Accurate Diagnosis of Headaches in Children

There are many factors that make diagnosis of headaches in children a challenge for clinicians. As a physician there are several determinations to make: is it a migraine or non-migraine; is it a primary or secondary headache; is there an emotional or psychosocial component?

The difficulty is compounded by the lack of a simple diagnostic test – there is no simple blood test or imaging scan that can correctly provide a diagnosis. A physical exam may reveal the cause of some headaches, but this is not usually the case.

A Thorough Clinical History Is Key

Conducting a detailed clinical history provides the most helpful diagnostic information. Depending on the patient’s age, this too can be a challenge as some children do not have the verbal skills or vocabulary to describe their symptoms, or an accurate memory of the history or frequency of their headache pain.

Your evaluation should include a detailed clinical history followed by a thorough general and neurological evaluation. It’s important to include input from all caregivers – teachers, parents, other family members. Children do not always communicate openly, or even recognize their pain, so some behavior may be referred from certain activities, such as abruptly quitting a video game, wishing to be in darkened rooms in daytime. Another way to engage children may be to ask them to draw a picture of what the headache feels like, since some may communicate better through pictures than verbally.  

Valley Children’s Hospital recommends that you follow these guidelines for referring headaches:

• Persistent or frequent (more than 1 per week) headaches not responding to first-line medications or for patients with headache associated with focal neurologic deficits.
• Patients with a new, severe headache of acute onset, headache with a focal neurologic deficit, or headache associated with papilledema should be referred to the Emergency Department

Find full neurology and neurosurgery guidelines here.

Comprehensive Pediatric Neuroscience in the Central Valley

If your pediatric patient has a suspected or confirmed neurological disorder, the Pediatric Neuroscience Center at Valley Children’s has the excellence and experience you need.